Provider Demographics
NPI:1174565600
Name:SVC DERMATOLOGY PC
Entity type:Organization
Organization Name:SVC DERMATOLOGY PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:SEIGER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:810-629-0336
Mailing Address - Street 1:305 N LEROY ST
Mailing Address - Street 2:
Mailing Address - City:FENTON
Mailing Address - State:MI
Mailing Address - Zip Code:48430-2729
Mailing Address - Country:US
Mailing Address - Phone:810-629-0336
Mailing Address - Fax:810-629-7251
Practice Address - Street 1:305 N LEROY ST
Practice Address - Street 2:
Practice Address - City:FENTON
Practice Address - State:MI
Practice Address - Zip Code:48430-2729
Practice Address - Country:US
Practice Address - Phone:810-629-0336
Practice Address - Fax:810-629-7251
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0B514150OtherBLUE CROSS MICHIGAN
MI0P31190Medicare PIN
MI0P31170Medicare PIN